Health-related quality of life and patient reported outcomes among people living with HIV and cancer

项目总结 艾滋病毒治疗的进步提高了艾滋病毒感染者(PWH)的预期寿命。由于威尔斯亲王的寿命更长， 与普通人群相比，他们患癌症和癌症相关死亡的风险更高。 然而，目前还不清楚哪些因素可能导致持续的存活率差异和较差的癌症。 美国威尔斯亲王医院的结果。将患者报告结果(PRO)的测量纳入常规 而支持性癌症护理是改善威斯康星医院生活质量、癌症结局和生存率的潜在策略。 PRO包括由患者直接报告的数据，以描述他们的感觉和功能，如症状， 身体功能和与健康相关的生活质量。在普通(即，未感染艾滋病毒的)癌症患者群体中， PRO评分与几种不良癌症临床结果有关，包括治疗反应差， 癌症的进展和较短的生存期。鉴于PWH也更有可能被诊断为非艾滋病 在癌症定义为晚期并经历死亡率上升的情况下，迫切需要研究机会，如 作为专业人员的作用，以提高存活率，并最终减少可预防的癌症死亡的威尔斯亲王。然而， 据我们所知，目前还没有关于威斯康星医院的PRO和总体健康相关生活质量的研究。 得了癌症。为了解决这一研究差距，我们的目标是评估身心健康症状 (PRO)HIV阳性患者的整个癌症诊断轨迹及其与癌症预后的关系 癌症患者。我们提出了一个双管齐下的方法：我们将利用NCI赞助的现有数据链接 监测、流行病学和最终结果(SEER)癌症登记数据和医疗保险中心之间的关系 和医疗补助服务(CMS)的医疗保险健康结果调查(MHOS)(目标1和2)，并进行初选 在NCI指定的癌症中心接受治疗的HIV阳性癌症患者的数据收集(AIM 3)。我们会 实现以下具体目标：目标1：比较术后患者报告结果(PRO)的变化 非艾滋病患者的癌症诊断：确定携带和不携带艾滋病毒的癌症患者；目标2：估计 PRO(诊断前、诊断后和PRO的变化)与老年人总存活率的关系 被诊断为非艾滋病的患者定义为携带艾滋病毒的癌症；和目标3：探索艾滋病毒特异的临床作用 在广泛年龄范围的HIV阳性癌症中，患者报告的结果评估中的社会因素 在NCI指定的癌症中心接受治疗的患者。这项研究的发现将提供初步数据 告知未来大规模R01级别研究的发展机会，重点是改善症状 癌症合并PWH的控制和评估定制患者报告结果数据的整合 为这一弱势群体提供常规的支持性护理。

PROJECT SUMMARY Advances in HIV treatment have improved life expectancy among people with HIV (PWH). As PWH live longer, they are at increased risk for cancer and cancer-related mortality compared with the general population. However, it remains unclear what factors may contribute to persistent survival disparities and poor cancer outcomes among PWH in the US. Integrating measurement of patient-reported outcomes (PROs) into routine and supportive cancer care is a potential strategy to improve PWH’s quality of life, cancer outcomes, and survival. PROs encompass data reported directly by patients to describe how they feel and function, such as symptoms, physical function, and health-related quality of life. In the general (i.e., HIV-uninfected) cancer patient population, PRO scores are associated with several adverse cancer clinical outcomes including poor response to therapy, cancer progression, and shorter survival. Given that PWH are also more likely to be diagnosed with non-AIDS defining cancers at later stages and experience elevated mortality, it is urgent to investigate opportunities, such as the role of PROs, to improve survival and ultimately reduce preventable cancer deaths among PWH. However, to our knowledge, no research exists in the context PROs and overall health-related quality of life among PWH with cancer. To address this research gap, our objective is to evaluate physical and mental health symptomology (PROs) throughout the cancer diagnosis trajectory and associations with cancer outcomes among HIV-positive cancer patients. We propose a two-pronged approach: we will leverage an existing, NCI-sponsored, data linkage between the Surveillance, Epidemiology, and End Results (SEER) cancer registry data and Centers for Medicare and Medicaid Services (CMS)’ Medicare Health Outcomes Survey (MHOS) (Aims 1 and 2) and conduct primary data collection among HIV positive cancer patients treated at an NCI-designated cancer center (Aim 3). We will carry out the following specific aims: Aim 1: Compare changes in patient reported outcomes (PROs) after a cancer-diagnosis among non-AIDS defining cancer patients living with and without HIV; Aim 2: Estimate associations of PROs (pre-diagnosis, post-diagnosis, and change in PROs) with overall survival among older patients diagnosed with non-AIDS defining cancers with HIV; and Aim 3: Explore the role of HIV-specific clinical and social factors in patient reported outcome assessments among a broad age range of HIV positive cancer patients treated at one NCI-designated cancer center. Findings from this research will provide preliminary data to inform the development of future large-scale R01-level research opportunities focused on improving symptom control among PWH with cancer and evaluating the integration of tailored patient-reported outcome data collection into routine supportive care of this vulnerable population.